Consumption of fentanyl and drug overdoses are on the rise across Virginia, and the two trends are often linked because of fentanyl in disguise.

The problem hasn’t bypassed the Northern Neck, and due to challenges identifying drug overdose trends, there’s the risk that these issues could become embedded in local communities before law enforcement and health authorities recognize them, a discussion with Kathrin Hobron, forensic epidemiologist for VDH Office of the Chief Medical Examiner revealed.

State and local issues

In 2013, fatal drug overdose became the leading cause of unnatural death in Virginia, and the numbers are still rising. “With cases up over 40 to 50 percent since 2019, drug overdoses have been a huge strain,” said Hobron. 

“I can say specifically that fentanyl has been in so many of our drug deaths. I think it’s upwards of 75 to 80 percent of all drug deaths statewide in 2020 were involved with fentanyl,” she added.

In many cases, people aren’t aware that they’re consuming fentanyl. “People think they’re buying cocaine or an oxycodone or something like that and it’s either just fentanyl completely or fentanyl laced in it. That’s been very problematic. We’ve seen it all over the state,” said Hobron.

Sheriff C.O. Balderson has observed it right in Westmoreland County. “We have seen an increase in fentanyl usage, and we are still seeing the mixture of heroin and fentanyl, which is extremely dangerous,” he said. And “with an increase in fentanyl use, the risk of overdoses and possible deaths increase, which adds another dynamic to sheriff’s office personnel as well as all first responders.”

A few months ago, Lancaster authorities responded to an incident where two people had overdosed. Sheriff Patrick McCranie confirmed fentanyl was involved.

And Northumberland County Sheriff Johnny Beauchamp said his office has also seen an increase in reported overdose cases. “When fentanyl is introduced into the picture, it makes the drug problem worse,” he explained.

Individuals assuming they are purchasing some form of pharmaceutical drug are unaware of the presence of fentanyl. “The manner in which pills or tablets are mixed and pressed by illegal manufacturing contribute to the alarming rate of overdoses because one pill may contain less than a fatal dose of fentanyl and the very next pill may contain twice the amount for a fatal overdose,” he said.

However, Beauchamp said not all of Northumberland’s overdoses are fatal and some do not involve fentanyl. 

Problems detecting trends

In some areas when authorities are aware of trends, such as a high prevalence of fentanyl-laced drugs or deaths linked to particular drug trends, they launch public awareness campaigns, Hobron explained. But for several reasons, it can be difficult getting to the point of identifying those trends.

Like Beauchamp, Hobron pointed out that deaths are only one component of the drug overdose epidemic. So, an issue like fentanyl-laced drugs could be far more prevalent in a community than it seems because the numbers of non-fatal overdoses could be rising below the radar.

To link specific types of drug deaths and with specific types of hospitalizations, requires analyzing different data sets, and that is complicated by range of issues.

For example, deaths are counted in the location where they occurred, meaning if an individual buys and consumes drugs in the Northern Neck but dies in a hospital in Richmond City that death is linked to the city. 

And when you’re cross-referencing data such as deaths, hospitalizations and drug seizures, the information is reported based on different locations. Some information is reported by county, some by Virginia State Police Divisions and others by Virginia Health Districts, increasing the challenge of grasping what’s going on in a particular location.

Catching trends is further complicated by the fact that state authorities are having a hard time reporting and data is delayed, so the numbers don’t reflect what is happening right now. For example, Virginia Department of Health was producing quarterly reports for emergency room overdose visits but amid COVID-19 has suspended those reports until further notice.

Hobron said 2020 data isn’t available yet so it’s not possible to see what has been happening since the pandemic began.

Another problem is that since a lot of drug deaths now involve multiple drugs, they’re counted in the data for each drug detected. So, one death is commonly counted in a report multiple times.

And to further exacerbate matters, toxicology is slow. Northumberland is investigating an alleged overdose that killed a 31-year-old woman. In a case like that, Hobron said toxicology results can take up to three months to get back, and that type of lag creates another challenge in early detection of dangerous drug trends.

Then, there is the High Intensity Drug Trafficking Areas Program, a national initiative that has different platforms that could be used to look for spikes in overdoses. “It could be a valuable tool for law enforcement and health authorities, but there has been an issue getting Virginia hooked onto the system because of legal issues,” said Hobron.